Anastomosis occlusion device

ABSTRACT

An anastomosis occlusion device having a low-profile shaft assembly configured for insertion into the lumen of a vessel and a distal perfusion system adapted to be connected to the shaft assembly. The device includes an expandable region at the shaft assembly distal end with a sealing membrane that spans the expandable region, and a corresponding clamping member moveable toward the expandable region. Once inserted into the vessel lumen the expandable region is deployed from a first low-profile position into a second expanded position, and positioned at the target site of the anastomosis. Movement of the distal end of the clamping member, which remains located outside the vessel, against the expanded region creates a seal at the target site allowing a blood-free, graft site.

[0001] This application is a Continuation-in-Part of (CIP) of Ser. No.09/887,477, filed Jun. 22, 2001, which in turn claims benefit ofpriority under 35 U.S.C. §119(e) from U.S. Serial No. 60/270,946, filedFeb. 21, 2001, and Serial No. 60/282,545, filed Apr. 9, 2001, each ofwhich is incorporated herein in its entirety.

BACKGROUND OF THE INVENTION

[0002] The present invention relates to the fields of vascular andcardiovascular surgery, and more particularly to methods and devices forobtaining arterial or vascular occlusion when performing graftprocedures.

[0003] Vascular and cardiovascular grafting procedures typically requirethe complete, or at least partial, occlusion of a selected vessel. Forexample, in the field of cardiovascular surgery, coronary artery bypassgraft (CABG) procedures involving proximal anastomosis require the full,or at least partial, occlusion of the aorta. During proximalanastomosis, a vein or arterial graft is sewn to the aorta forrevascularization of diseased or otherwise compromised coronaryarteries. The internal mammary artery and radial artery of the arm arealso used as bypass vessels. Occlusion of the aorta is typicallyaccomplished by clamping. A variety of clamp configurations are incommon use, including crossclamps for partial occlusion procedures. Forprocedures involving cardiopulmonary bypass, full aortic occlusion isrequired. Partial occlusion is used in either on or off-pump coronaryartery bypass graft procedures for proximal anastomosis. Occlusion ofthe aorta prevents blood flow from entering the graft target site,creating a bloodless field for the surgeon to then sew the graft to theaorta. Once the graft is sewn to the aorta, the surgeon removes theclamp, once again allowing blood flow to the anastomotic region.

[0004] Unfortunately, injury resulting from such clamping can besignificant. Such injuries include, but are not limited to, intimalhyperplasia, thrombosis (which may progress to total occlusion),embolism, intimal tears and flaps, mural dissections, aneurysms,arterial rupture, through-and through injury, and arterio-venousfistulae. As just one example, neurologic morbidity after cardiacsurgery has been associated with particulate embolization. Crossclampmanipulation has been identified as the single most significant cause ofparticulate emboli release during cardiac surgery. Therefore, surgeonswould prefer to eliminate the use of clamps during coronary arterybypass graft procedures in order to minimize adverse events and improveoutcomes.

[0005] Efforts have been made to devise alternative devices and methodsfor performing bypass graft procedures that avoid complete clamping orcrossclamping of the aorta. For example, U.S. Pat. No. 5,477,515describes a bypass clamp with a spoon-shaped blade insertable through anincision in the aorta. Patches of saphaneous vein or other substituteare sutured on either side of the incision to reinforce the aorta andprevent tearing or abrasion by the clamp. U.S. Pat. No. 5,944,730describes a device for creating a seal at an incision that includes atube with a translatable shaft connected to a flexible inverting member.The inverting member is inserted into the incision and proximal forceapplied to the device creates a seal. Other methods have relied uponinflatable devices for partially occluding a vessel without interruptingblood flow. U.S. Pat. No. 6,143,015 describes such a device whichincludes first and second inflatable spaced apart members interconnectedby a tubular connector that allows for blood flow.

[0006] Despite these efforts, there remains a need to provide for ananastomosis occlusion device that minimizes the adverse eventsassociated with conventional clamping and crossclamping techniques,avoids trauma to the vessel and graft site, that is versatile andeasy-to-use.

SUMMARY OF THE INVENTION

[0007] The present invention meets the above needs and achieves furtheradvantages by providing for an anastomosis occlusion device and methodsfor use in grafting procedures that minimize trauma and adverse eventsassociated with grafting procedures, including trauma and adverse eventscurrently associated with coronary artery bypass graft procedures.

[0008] In particular, the invention provides for a low-profile shaftassembly that is configured for insertion into the lumen of the aorta(or other selected vessel) and that includes an expandable region at thedistal end of the shaft assembly. The expandable region includes asealing membrane that spans across the expandable region. Once insertedinto the lumen of the aorta (or other selected vessel) this expandableregion can be deployed from a first low-profile position into a secondexpanded position, and positioned at the target site of the anastomosis.A clamping member, located outside the vessel, is also provided having adistal end that is shaped to correspond to the expandable region of theshaft assembly in its second expanded position. Movement of the distalend of the clamping member against the expanded region creates a seal atthe target site, defined by the border of the expanded region of theshaft assembly and the sealing membrane. This sealed-off area is thustemporarily segregated from bloodflow at the target site to facilitateperforming a grafting procedure without undue blood pressure or leakageinterfering with the procedure.

[0009] One of the many advantages of the invention is that the insertionsite of the device and means for deploying the expandable region fromthe first low-profile position to the second expanded position, as wellas means for moving the clamping member toward the expandable region,are located remote from the anastomosis site. This remote location ofthese features allows for a less cluttered surgical field at the graftsite itself, giving the surgeon a clearer field of view and more room toperform the procedure. Another of the many advantages of the inventionis in the low-profile nature of the shaft assembly itself. By“low-profile” it is meant that the distal end of the shaft assembly, inits non-deployed, low-profile position, has a cross-sectional profilethat is the same as, or only slightly larger, than the cross-sectionalprofile of remainder of the shaft assembly. This minimizes the size ofthe incision, puncture, or stick necessary to introduce the shaftassembly into the vessel and otherwise minimizes trauma to the vesselduring insertion of the shaft assembly into the vessel. In many cases,the insertion site will be self-sealing upon removal of the assembly, orwill otherwise at most require very minimal suturing. In addition,because the expanding region is deployable to its expanded positionafter its insertion into the vessel, the invention allows for the use ofspecific instrument configurations that would otherwise not be feasibleto introduce directly through a vessel wall without unwarranted traumato the vessel. For example, the specific configurations that areattainable by deploying the expanding region of the present inventionafter insertion into the vessel would otherwise require making largeincisions to accommodate their introduction into the vessel.

[0010] In one embodiment of the invention, a shaft assembly is providedhaving a flexible tube extending over the shaft assembly with the distalend of the flexible tube secured to the distal end of the shaftassembly. The distal end of the flexible tube further includes anexpanding region having bowing portions, with a sealing membraneattaching to the bowing portions. Movement of the flexible tube relativeto the shaft assembly in the direction of the distal end of the assemblycauses the bowing portions to bow outward, creating the expanded regionof the assembly, with the sealing membrane spanning the expanded region.

[0011] In another embodiment of the invention, the shaft assemblyincludes a fixed shaft and a rotatable shaft that are axially aligned,each of which has corresponding bowing portions at the distal end of therespective shafts that extend away from the axis of the assembly. Asealing membrane is secured to and spans the bowing portions of theshafts. Rotation of the rotatable shaft causes the bowing portions ofthe shafts to become spaced apart from one another, creating an expandedregion with the sealing membrane extending across the region.

[0012] Control of the deployment of the expandable region and movementof the clamping member toward the expandable region can either beoperably linked or independent. In one embodiment of the invention, theclamping member includes an actuator that engages a slide that in turnengages the shaft assembly. Movement of the clamping member toward theexpandable region moves the slide via the actuator, which thensimultaneously moves the shaft assembly, resulting in the deployment ofthe expandable region. Alternatively, the invention also provides fordeployment of the expandable region and movement of the clamping memberindependently. In one such embodiment, the shaft assembly includes thedescribed axially aligned fixed and rotatable shafts which controldeployment of the expandable region. The shaft assembly and clampingmember are pivotally linked and also include handles, such thatactuation of the handles moves the shaft assembly and clamping memberindependent of the expandable region deployment. In another embodiment,the clamping member is controlled by a turn screw mechanism and thedeployment of the expandable region is controlled by an independentslide actuator.

[0013] In another embodiment of the invention, a device is providedhaving a housing with a clamping member pivotally mounted to the housingand a slide located within the housing and moveable from a firstposition to a second position. A shaft assembly is connected to theslide and extends therefrom. A flexible tube extends over the shaftassembly, the proximal end terminating near the housing and the distalend secured to the distal end of the shaft assembly. The distal end ofthe flexible tube includes an expanding region having first and secondbowing portions, with a sealing membrane attaching to said bowingportions. The clamping member includes an actuator which engages theslide and a lever arm extending from the clamping member and terminatingin a distal end defining a particular geometry. Upon movement of theclamping member, the actuator causes movement of the slide and shaftassembly, and the distal end of the flexible tube is displaced, forcingthe bowing portions to bow outward, creating an expanded region of thetube with the sealing membrane stretched over the region. The distal endof the lever arm is shaped in a complementary pattern to the expandedregion.

[0014] In use, the shaft assembly of a device according to the inventionis introduced into the lumen of the aorta until the distal end of thetube is positioned beneath a target region at the graft site. A hole iscreated at the target region, either prior to or after positioning ofthe device. Actuation of the device clamps the vessel wall between thetop clamp and expanded region of the flexible tube of the device,creating a seal against blood flow into the graft area. The surgeon canthen proceed with performing the anastomosis in an essentially bloodlessfield.

[0015] In another embodiment of the invention, an occlusion device isprovided having a shaft assembly and a clamping member pivotally mountedfor movement toward and away from one another. The shaft assemblyincludes a fixed shaft and a rotatable shaft that are axially aligned,each of which has corresponding bowing portions at the distal end of therespective shafts that extend away from the axis of the assembly. Asealing membrane is secured to and spans the bowing portions of theshafts. Rotation of the rotatable shaft causes the bowing portions ofthe shafts to become spaced apart from one another, creating an expandedregion with the sealing membrane extending across the region. Theclamping member that is pivotally mounted for movement toward the shaftassembly includes a distal end having a configuration that correspondsto the expanded region of the shaft assembly when the bowing portionsare in the described spaced apart configuration. In operation, the shaftassembly is introduced into the aorta, and then the bowing portions aredeployed into the spaced apart configuration at the graft site. Theclamping member is then moved toward the shaft assembly, clamping thevessel wall between the distal end of the clamping member and the distalend of the shaft assembly in the deployed, spaced apart configuration,creating a sealed off area for performing the graft.

[0016] In yet another embodiment of the invention, an occlusion deviceis provided having a housing with a slide located within the housingthat is moveable from a first to a second position. A shaft assemblyextends from the housing and includes a control rod extending throughthe length of the shaft assembly, an expandable region at the distal endof the shaft assembly, and a sealing membrane likewise at the distal endof the shaft assembly that spans the expandable region. The control rodis connected at its proximal end to the slide and at its distal end tothe distal end of the shaft assembly. The expandable region isdeployable from a first, low-profile position to a second expandedposition. A clamping member is pivotally mounted to and extends from thehousing. The distal end of the clamping member is shaped to correspondto the expandable region of the shaft assembly in its second expandedposition. The device includes separate, independent actuators fordeploying the expandable region of the shaft assembly into its expandedposition and for pivotally moving the clamping member toward and awayfrom the shaft assembly.

[0017] In another aspect of the invention, a lumen in fluid connectionwith an injection port and one or more delivery ports that open to thesurface of the shaft assembly are provided, thus allowing for convenientmeans for delivering tissue adhesives, sealants or other agents to theanastomosis site, as well as allowing for general means of administeringan agent into the bloodstream.

[0018] In a further aspect of the invention, a perfusion tube in fluidcommunication with a lumen extending through the shaft assembly isprovided, the perfusion tube terminating in a sealing bulb adapted fordeployment within a vessel. In use, the perfusion tube can provide fordistal perfusion of the coronary artery (or other target vessel) duringthe graft procedure.

[0019] In yet another aspect of the invention, a filter is provided thatis deployable downstream of the anastomosis site. The filter can collectand trap any debris or particulate matter that is loosened from thevessel wall during the anastomosis procedure.

[0020] In a further aspect of the invention, an occlusion deviceaccording to the invention is provided that is adapted for laproscopicuse.

BRIEF DESCRIPTION OF THE DRAWINGS

[0021]FIG. 1 is a perspective view of an anastomosis occlusion deviceaccording to one embodiment of the invention, with the device in anopen, non-occluding position;

[0022]FIG. 2 is a side view of the occlusion device of FIG. 1;

[0023]FIG. 2a is an end view of the occlusion device of FIG. 1;

[0024]FIG. 3 is a side view of the occlusion device of FIG. 1, with thedevice in a closed, occluding position;

[0025]FIG. 3a is an end view of the occlusion device of FIG. 3;

[0026]FIG. 3b is a perspective view of the occlusion device of FIG. 3;

[0027]FIG. 4 is a perspective view of the occlusion device of FIG. 1,showing a shaft assembly portion of the device partially inserted intoan aortic opening;

[0028]FIG. 5 is a perspective view of the occlusion device of FIG. 4,with the shaft assembly portion and clamp arm positioned at ananastomosis site of the aorta, and with the device in a closed,occluding position.

[0029]FIG. 6 is a perspective view of an anastomosis occlusion deviceaccording to a second embodiment of the invention;

[0030]FIG. 7 is an expanded view of the occlusion device of FIG. 6, withparts broken away, showing the distal end of the device in an expandedconfiguration for occlusion;

[0031]FIG. 8 is a perspective view of an occlusion device according to athird embodiment of the invention;

[0032]FIG. 9 is an expanded view of the device of FIG. 8, with partsbroken away, showing an shaft assembly of the device in an expandedconfiguration;

[0033]FIG. 10 shows another view of the shaft assembly of FIG. 9 in anexpanded configuration;

[0034] FIGS. 10A-10C show cross-sectional views of the shaft assembly ofFIG. 10, taken along lines 10A-10A, 10B-10B and 10C-10C of FIG. 10,respectively;

[0035]FIG. 11 shows a cross-sectional side view of the device of FIG. 8;

[0036]FIG. 12 shows an expanded cross-sectional side view, with partsbroken away, of the distal end of the shaft assembly of the device ofFIG. 11;

[0037]FIG. 13 shows an introducer device for use with the device of FIG.8;

[0038]FIG. 14 shows a front end view of the introducer device of FIG.13;

[0039]FIG. 15 shows an occlusion device according to FIG. 8 in operationand further provided with a perfusion tube assembly, for distallyperfusing the target vessel;

[0040]FIG. 16 shows an expanded view of the distal end of the perfusiontube of FIG. 16, deployed within the target vessel with the vessel wallpartially broken away.

DETAILED DESCRIPTION OF THE INVENTION

[0041] FIGS. 1-5 depict one embodiment of an occlusion device accordingto the present invention. FIGS. 1, 2, and 2 a show occlusion device 10in the opened, non-occluding position. As seen, the device includeshousing 20 formed of opposed plates 12 and 14. Slide 22 is slideablydisposed within the housing and includes arms that extend into ports 16and 18 of plates 12 and 14, allowing for linear translational movementof the slide relative to the housing. Shaft assembly 40 extends fromslide 22, terminating at distal end 42 away from the housing. Clampingmember 33 is positioned between plates 16 and 18 and is pivotallymounted to the housing by pivot 31, which may be a pin. The clampingmember further includes lever 30, actuator 32, which engages slide 22and remains disposed within the housing, and lever arm 34 which extendsfrom the housing. Lever arm 34 terminates at its distal end in topclamping portion 36. Post 24 is secured to housing 20 in the samegeneral plane as lever 30, shaft assembly 40 and lever arm 33. Post 24includes ratchet 26 which matingly engages with lever 30.

[0042] As shown, shaft assembly 40 is surrounded by flexible tube 50.The shaft assembly 40 is preferably formed of rigid biocompatiblematerial, such as stainless steel. The flexible tube is preferably madeof a plastic, such as Hytrel™, having a durometer in the range of 60-90Shore D and a length between 1″ and 3″. A shown in FIG. 2, threevertical through holes 51, 52, and 53 are drilled into the distal end,and a through slot 55 is cut through the tube, connecting the threeholes. The distal tip of the shaft assembly 40, which remains locatedinside the flexible tube, is permanently secured to the distal tip ofthe flexible tube, but the remainder of the flexible tube is free tomove relative to the shaft assembly 40. The proximal end of the flexibletube can be secured to the housing, or can otherwise abut up against thehousing or terminate at a position near the housing, as shown in FIGS. 1and 2. The proximal end of shaft assembly 40 is secured to slide 22. Anelastomeric sealing membrane 60, essentially a sleeve and preferablyformed of silicone, is secured around and along the length of theflexible tube. Alternatively, the sleeve can extend around the distalend of the tube, provided the sleeve covers that portion of the tubecontaining the holes 51, 52, and 53 and through slot 55. In the depictedembodiment, the wall thickness of the silicone is between 0.008″ to0.015″, giving an overall diameter of shaft-flexible tube-sleevecylindrical assembly in the range of 0.070″ to 0.110″, and the overalldimensions of the device are 3.5×3.5×0.4″ or less. One skilled in theart will appreciate that the dimensions can be varied to optimizeperformance based on the dimensions of the particular vessel to beoccluded.

[0043]FIGS. 1, 2 and 2 a depict device 10 in the open, non-occludingposition. FIGS. 3, 3a, and 3 b depict the device in the closed, occludedposition. The device is actuated by moving lever 30 of clamping member33 toward post 24. This motion has two effects. The first effect is thatactuator 32 is thus displaced, forcing slide 22 to move laterally of thehousing, away from the post. This in turn causes lateral displacement ofshaft assembly 40 and forces the distal tip of flexible tube 50 todisplace as well. The proximal end of flexible tube 50, however, isrestrained by housing 20, so that the application of continueddisplacement force at the tip causes the bowing portions 56 and 57 tobow outwardly to accommodate tip displacement, as seen in FIGS. 3a and 3b. In the instant embodiment, the provision of holes 51, 52, and 53weakens the relative rigidity of those corresponding regions of thetube, providing natural flex points along the two sides of the splitportion of the tube, which allow for the bowing portions to bowoutwardly into a predetermined pattern. In particular, the bowingportions of the instant embodiment expand into a diamond shape, althoughthose skilled in the art will recognize that the invention contemplatesarrangements of other flex points to create bowing portions that candisplace into a variety of patterns. As also seen in FIGS. 3a and 3 b,as the bowing portions expand outwardly, elastomeric sealing membrane 60stretches to form a relatively planar sheet spanning the now createddiamond pattern.

[0044] The other effect of moving lever 30 of clamping member 33 towardpost 24 is that such movement causes lever arm 34 and top clampingportion 36 to be moved toward the now diamond shaped distal end of theflexible tube. As depicted, top clamping portion 36 is a wire form thatmatches and follows the contours of the outer edge of the expandedflexible tube. In the instant embodiment, top clamping portion 36 isdiamond shaped, but in other embodiments, the clamping portion will beof a shape to match the pattern formed by the expanded distal end of theflexible tube, such as, but not limited to, round or oval shapes.Ratchet 26 engages lever 30 to lock the device in the closed position.The lever is spring loaded (not shown), allowing the device to return toits open position when the ratchet is disengaged.

[0045] The device of the present invention is designed for use in anoff-pump procedure, with the heart beating and blood flowing through theaorta. As shown in FIG. 4, with device 10 in the open position, theshaft assembly 40 and flexible tube 50 assembly is inserted into theaorta (A) via an introduction hole (H). There are a variety of methodsto accomplish such insertion. For example, the introduction hole can becreated by a simple scalpel stick or needle puncture. Alternatively, astandard introducer can be employed, which would typically include astylet, obturator and one-way hemostasis valve. Once the introducer isplaced, the shaft assembly is passed through the introducer and into theaorta, and hemostasis is maintained by means of the introducer valve. Inaddition it may also be desirable to provide a guidewire passing throughthe introducer over which the shaft assembly can subsequently be passedand guided to the desired location. In such an event, the shaft assemblyof the device can be hollow to accommodate the guidewire, or canotherwise be provided with one or more lumens to accommodate theguidewire.

[0046] Using an arterial punch, hole (P) is then punched through theaorta at the intended site of grafting, and ahead of the distal tip ofthe device. As shown in FIG. 5, device 10 is further advanced such thatthe distal end of the flexible tube and top clamping portion of thelever arm 33 are over the hole. Alternatively, the device can first bedeployed to the target site prior to punching the hole. Once positioned,the device is then actuated to its closed position. This results in thedevice “sandwiching” the vessel wall between the expanded flexible tuberegion and the top clamping portion. Stretched sealing membrane 60 sealsblood from exiting the vessel through the punched hole. With the devicesecured in the closed position by means of the ratchet, a surgeon is nowable to suture the graft around the circumference of the punched hole ina bloodless field. When the graft is sutured, the surgeon disengages theratchet, returning the device to its open position, and removes thedevice through the introduction hole. Finally, the introduction hole issutured closed.

[0047] As mentioned, methods of deploying the device of the inventioncan also incorporate, e.g., an introduction method using a hollowstainless steel shaft assembly. This facilitates guidewire introduction,a common technique used with catheters. The device can be introducedthrough the hollow shaft assembly, or if a guidewire has been deployedthe device can be positioned by running the device over the guidewire.The invention also contemplates providing a kit that can include thedevice itself, as well as one or more of the following components:guidewire, introducer, introducer needle, dilator, aorta punch.

[0048]FIGS. 6 and 7 depict a second embodiment of the invention. In thisembodiment, occlusion device 110 includes opposable clamping member 134and shaft assembly 140 that are pivotally mounted for movement towardand away from one another. In particular, member 134 and shaft assembly140 are connected at hinge 113, with handles 112 and 111 extending fromclamping member 134 and shaft assembly 140, respectively. Actuation ofthe handles causes relative movement of the clamping member 134 andshaft assembly 140 toward or away from one another.

[0049] Shaft assembly 140 is further made up of two shafts 141 and 142that are aligned with one another, as shown, along the axis of shaftassembly 140. The shafts 141 and 142 are of generally the sameconfiguration and are coupled to one another by sleeves 145, 146, and147. At the distal end of each shaft are bowing portions 156 and 157which extend away from the axis defined by the shaft assembly 140itself. Fixed shaft 141 is connected to handle 111. Rotatable shaft 142is coupled to shaft 141 and remains free to rotate about the axis of theshaft assembly. Lever 130 extends from the proximal end of shaft 142.Sealing membrane 160 is secured to bowing portions 156 and 157.

[0050] By rotating shaft 142, bowing portions 156 and 157 of shafts 141and 142 can be moved from an aligned position, where the portions areside by side, to an open, spaced-apart configuration where the bowingportions are opposite one another and define a plane and membrane 160extends between the bowing portions. This open, spaced-apartconfiguration defines an expanded region at the distal end of the shaftassembly 140, with sealing membrane 160 spanning the region. Sealingmembrane 160 can be formed of a variety of materials, provided theycreate an impermeable barrier. It is preferred, but not necessary, thatthe material have elastomeric properties, such as a silicone. Movementof lever 130, which is offset from shaft 142, provides a convenient wayto rotate shaft 142 and position the bowing portions of the shafts 141and 142 into the described spaced-apart configuration.

[0051] Clamping member 134, which is opposed to shaft assembly 140,includes a distal end having a clamping portion 136. Clamping portion136 is configured to correspond to the shape of bowing portions 156 and157 when in their expanded, spaced-apart configuration.

[0052] In operation, shaft assembly 140 is advanced into a vessel from aremote introduction hole with shafts 141 and 142 positioned such thatthe bowing portions 156 and 157 are aligned and side-by-side. In thislow profile configuration, the shaft assembly 140 is easily introducedand advanced into the vessel. Once positioned at the target anastomosissite, lever 130 can be actuated by the surgeon, thereby rotating shaft142 and creating the expanded region at the distal end of the assembly,with the sealing membrane spanning the expanded region. By actuating thehandles of the device, member 134 can be moved toward shaft assembly140, with clamping portion 136 of member 134 engaging the outer surfaceof the vessel and the expanded region of shaft assembly 140 engaging theinner surface of the vessel. A seal is then created at this clampedsite, allowing the surgeon to proceed with performing a graft at thetarget site as described. When complete, the member and shaft assemblycan be moved apart to release the seal, and shaft 142 rotated to returnshaft assembly 140 into a low profile configuration for removal from thevessel.

[0053] FIGS. 8-11 depict a third embodiment of the invention, which issimilar in some aspects to the first embodiment, but which furtherincludes independent means for actuating the expanding region of theshaft assembly 240 and the clamping member 234. Occlusion device 210includes housing 220, shaft assembly 240 and clamping member 234. Slide222 is slideably disposed within the housing for linear translationalmovement from a first to a second position. Shaft assembly 240 includescontrol rod 241 disposed within flexible tube 250, with the proximal endof rod 241 being secured to slide 222. Clamping member 234 is pivotallymounted by pivot 231 to the housing, and terminates at its distal end inclamping portion 236. Slide actuator knob 228 and clamping member 234actuator knob 227 are operably connected to slide 222 and member 234,respectively, as further described.

[0054] Flexible tube 250 can be formed of the same materials describedabove with respect to flexible tube 50 of FIGS. 1-5. Similarly, controlrod 241 is preferably formed of a rigid biocompatible material, such asstainless steel. As in the embodiment of FIGS. 1-5, flexible tube 250includes vertical through holes 251, 252, and 253 and through slot 255cut through the tube from through hole 251 to through hole 253. Controlrod 241 extends through the tube and is secured at its distal tip to thedistal end of the flexible tube. Again, as in the embodiment of FIGS.1-5, the remainder of the tube is free to move relative to the controlrod, and the proximal end of the tube is secured to housing 220 orotherwise abuts against the housing or terminates at a position near thehousing. Elastomeric sealing membrane 260, essentially a sleeve andpreferably formed of silicone, extends around at least that part of theflexible tube that includes through slot 255. The thickness of thesleeve and the overall dimensions of the shaft assembly 240 arepreferably as described above for the embodiment of FIGS. 1-5.

[0055] FIGS. 9-10 show the distal end of occlusion device 210 in theexpanded configuration. Such a configuration is achieved, much as withthe embodiment of FIGS. 1-5, by lateral displacement of control rod 241.Displacement of control rod 241 forces the distal tip of flexible tubeto likewise displace which in turn causes those portions of the flexibletube bisected by the through slot to bow outwardly in a predeterminedpattern. The elastomeric sealing membrane 260 stretches to accommodatethis movement, forming a planar sheet extending across the now expandedregion of the distal end of the shaft assembly 240.

[0056] As depicted in FIGS. 10A-10C, at the distal end of the shaftassembly 240, the elastomeric sealing membrane 260 is not contiguousaround the shaft assembly 240. Rather, a lengthwise gap 262 is providedin the sleeve, aligned with through slot 255 of the flexible tube 250.The remaining portion of the membrane 260 is adhered to the flexibletube 250. Upon deployment, as shown particularly in FIG. 10B, theelastomeric sealing membrane 260 stretches across the underside of theexpanded region. In operation, when the shaft assembly 240 is deployedinto a vessel and the top clamping portion of the clamping member 234 iscompressed against the expanded region, a seal is created at the clampsite, just as with the embodiment of FIGS. 1-5. However, by thisparticular configuration of having the seal created by the sleeve beingstretched only across the underside of the expanded region, a smallspace is created between the clamped vessel wall and the stretchedsleeve. The provision of this space is advantageous to the surgeon,facilitating grafting procedures with less risk of puncturing the sleeveand breaking the seal.

[0057] As seen in FIG. 8 and more clearly in FIG. 11, occlusion device210 includes separate actuating mechanisms for deploying the distal endof shaft assembly 240 into its expanded configuration and for moving topclamping portion 236 of clamping member 234 toward shaft assembly 240.As shown, slide actuator knob 228 is positioned external to the housingand has two spaced apart pins 281 and 282 that extend perpendicular toshaft assembly 240 and that are received by slide 222. In particular,slide 222 includes two cam portions 291 and 292 with receiving groove293 in between. Pin 281 is received within groove 293, and pin 282resides along the outer edge of cam portion 292, as shown when shaftassembly 240 is in the non-deployed position. A rotational force appliedto slide actuator knob 228 causes pin 281 to engage the slide, resultingtranslation movement of the slide relative to the knob and the housing.Continued rotation moves the slide until such movement results in theshaft assembly being in the fully open or deployed condition, at whichpoint pin 282 will have rotated all the way over and be in engagementwith the outer edge of cam portion 291. In this position, as well as inthe closed, non-deployed position, pins 281 and 282 are positionedhorizontally, relative to the top and bottom of the housing, and theknob is stabilized against movement. A threshold rotational force isrequired to move the slide from either of these positions. In thismanner, the knob acts to “lock” the shaft assembly in either the open,deployed, or the closed, non-deployed position.

[0058] Clamping member actuator knob 227 is located on the top portionof housing 220 and is axially connected to turn screw 271. Clampingmember 234, is operably connected to turn screw 271 by link 272.Rotation of actuator knob 227 turns the turn screw which raises orlowers arm 234 about pivot 231, and thus moves top clamping portion 236toward or away from shaft assembly 240. Gear 273 is likewise axiallyconnected to knob 227 and gear teeth along the gear circumference engagespring member 274. The gear and spring member assembly allows the turnscrew to be incrementally rotated, in either direction, in a controlledmanner. In this way, the force applied by the top clamping portion to aclamped vessel can be finely calibrated.

[0059] Occlusion device 210 can be inserted into a vessel and deployedsimilar to methods described above for the embodiment of FIGS. 1-5. Asdescribed, however, the expansion of the distal end region of shaftassembly 240, and the movement of clamping member 234 and top clampingportion 236 to clamp a vessel wall between expanded region of the shaftassembly and the top clamping portion, are performed independently,through the rotation of slide actuator knob 228 or clamping memberactuator knob 227. As seen in FIG. 8, occlusion device 210 can furtherbe provided with bleed back tube 233 and a connection means, e.g. luerlock 232. Observance of a backflow of blood from the bleed back tubeconfirms that the deployed shaft assembly is positioned within the lumenof the target blood vessel. The luer lock can then be engaged to stopfurther flow. Alternatively, a porous vent can be inserted which willallow air but not blood to escape.

[0060] Alternatively, as shown in FIGS. 11-12, occlusion device 210 canbe provided with stylet 290 that can be advanced through shaft assembly240 and extended from the distal end of the shaft assembly. The styletcan be used to create the entry hole in the vessel for entry of theshaft assembly, such that the creation of the entry hole and theinsertion of the shaft assembly into the vessel can be accomplished in asingle, convenient step. More particularly, control rod 241 is providedwith a lumen extending throughout the length of the rod. Stylet 290 isadvanced through luer lock 232, at the rear of the housing, and passedthrough the lumen of control rod 241 until the tip of the stylet extendsfrom the distal end of shaft assembly 240, as shown more clearly in FIG.12. Once the blood vessel has been pierced and the shaft assembly atleast partially advanced into the blood vessel lumen, the tip of thestylet can be withdrawn into the control rod lumen to avoid thepossibility of injury or trauma to the vessel.

[0061] FIGS. 13-14 depict a removable introducing device adapted for usewith occlusion device 210. As shown, introducing device 300 includeshalf-tube 302 which is essentially hemicylindrical. The distal end 303of the half-tube is beveled, providing a sharp point capable of piercingtissue. The proximal end of half-tube 302 is attached to housing 304.Housing 304 is configured to matingly engage with the bottom portion ofhousing 220 of device 210, whereby housing 304 can be held under tensionagainst bottom portion of housing 220. As shown, housing 304 includesspring clip 312 that extends from base 306 of housing 304. Sidewalls 308and 309 extend upwardly from base 306 and include retaining lips 314 and315 that extend inwardly from the top of the sidewalls. As shown in FIG.8, ridges 229 and 231 extend outwardly from either side of the bottomportion of housing 220. Occlusion device 210 can be secured tointroducer device 300 by pressing down on spring clip 312 while slidingridges 229, 231 of the occlusion device under retention lips 314, 315.The force supplied by spring clip 312 keeps ridges 229 and 231 of theocclusion device engaged with and retained against retention lips 314and 315. Half-tube 296 of introducing device 300 corresponds to shaftassembly 250 of occlusion device 210 with a slightly wider diameter,such that shaft assembly 250 is received within half-tube 296. Thedistal end 297 of the half-tube extends beyond the distal end of theshaft assembly 250. The introducing device allows the vessel wall to bepierced and the occlusion device inserted with a single motion. Theintroducing device can then be removed, leaving the shaft of theocclusion device deployed within the vessel lumen.

[0062] A further attachment to occlusion device 210 is perfusion tube400. As shown, perfusion tube 400 is adapted to connect to bleedbacktube 233 by way of a connection means, e.g., luer lock 232 (as discussedearlier in reference to FIG. 8) and luer fitting 420. Thus, whenocclusion device 210 is deployed in the aorta, as depicted in FIG. 15,perfusion tube 400 is in direct fluid communication with aortic blood.Perfusion tube 400 includes a variable length tube (2-10″) 430terminating in sealing bulb 440, which can be provided in various outerdiameters (1-5 mm). Perfusion tube 400 and sealing bulb 440 may be madefrom silicone or any biocompatible polymer or plastic. Inner lumen 450of perfusion tube 400 extends through sealing bulb 440, and opens to thedistal end 460 of the tube.

[0063] Perfusion tube 400, after placement in the arteriotomy, is shownin FIG. 16. Sealing bulb 440 diameter is chosen such that sealing bulb440, once placed, forms a seal with the vessel wall that preventsblackflow of blood. The proper size of sealing bulb 440 may bedetermined visually or variously sized sealing bulbs may be tried untila sufficiently sized bulb is found. In use, the distal perfusion device400 is inserted into the arteriotomy site of the diseased artery 465 ata location distal to blockage 470. Sealing bulb 440 and the use ofupstream Silastic™ bands 475 create a bloodless graft field 480. Whileanastomosis 485 is performed on the bypass vein 490, distal blood flow495 is maintained through the perfusion tube 400 and again back flow isprevented by the sealing bulb 400.

[0064] Perfusion tube 400 allows the blood for the distal perfusion tobe sourced directly from the aorta, as opposed to alternative sources,e.g., the femoral artery or exogenous supplies, thereby limiting thenumber of surgical procedures, patient trauma and risk of infection. Theuse of perfusion tube 400 further reduces the number of steps involvedin surgical procedures in that traditional means of accessing the aorticblood supply require additional steps to secure external attachments,e.g., a needle, to the aorta due to the aortic pressure.

[0065] A device according to the invention can further include a filterdeployable from the distal end of the device that can be used to trap,collect and remove any debris that is loosened from the vessel wallduring the deployment and use of the device. The filter can convenientlybe formed of a mesh, screen or filter material that will trapparticulate matter while allowing blood to pass through the filter.Suitable materials for forming the filter include, e.g., a thermoplasticor stainless steel mesh, or a porous elastomeric membrane. The filtercan be deployed through, e.g., a hollow shaft assembly of the device, ora lumen otherwise provided through the shaft assembly. Alternatively,the filter can be deployed separately from deployment of the occlusiondevice of the invention and used in conjunction therewith.

[0066] Various types of filters are contemplated by the invention. Onesuch embodiment includes a tubular sock shaped mesh net extending from aloop structure. The loop structure can be offset from a guidewire.Typical filters having such a general configuration are FILTERWIRE™embolic filters (Embolic Protection, Inc., Campbell, Calif.). In thepresent invention, the loop can be formed of a deformable shape memoryalloy, allowing it to be passed through or retained in a lumen of theshaft assembly of the occlusion device. In operation the filter isdeployed downstream of the anastomosis site. It is preferred that theloop diameter conform as much as possible to the inner diameter of thevessel, in order to maximize the chance to trap any loosened debris.Once the procedure is complete, the filter can be withdrawn back intothe lumen of the occlusion device, or, if the volume of collected debrismakes such withdrawal unfeasible, the occlusion device can first beremoved from the vessel, followed by the filter. In another embodimentof a filter according the present invention, the filter has aconfiguration similar to an umbrella and is again deployable through thelumen of the occlusion device. In a filter according to this embodiment,an offset central elongated support is extendable from the lumen. Meshis secured to ribs radially extending from the distal end of theelongated support and are further attached to a longitudinally moveableportion of the support such that the filter can be “opened” oncedeployed in the lumen vessel to span the inner diameter of the vessel.Again, after completion of the procedure, the filter can be “closed”thus trapping the collected debris and, depending on the volume ofdebris collected, either retracted back into the lumen of the occlusiondevice or removed from the vessel separately. In yet another embodimentof a filter according to the invention, mesh of a generallyhemispherical configuration can be attached to a plurality of tethers,much like a parachute, and deployed from the lumen of the occlusiondevice.

[0067] As mentioned, the shaft assembly can be hollow or otherwiseprovided with one or more lumens to facilitate the use of a guidewire ordebris filter. Such passageways or lumens can also be employed fordelivery of fluids or other agents to the anastomotic site, or elsewherealong the shaft assembly. Delivery ports that open to the shaft assemblysurface are provided that are in fluid communication with thepassageways or lumens. An injection port is likewise provided at theproximal end of the shaft assembly in fluid communication with apassageway or lumen, as is typically found in, e.g., a fluid deliverycatheter or similar device. Of particular interest is the delivery oftissue adhesives, i.e., glues, and tissue sealants to the anastomosissite. Suitable tissue adhesives include protein-based surgicaladhesives, such as BIOGLUE™ brand surgical adhesive (which containsalbumin and glutaraldehyde) (CryoLife, Kennesaw, Ga.). Suitable tissuesealants include thrombin based products, such as FLOSEAL™ sealant(collagen and thrombin) (Fusion Medical Technologies, Fremont, Calif.),COSTASIS™ sealant (collagen and thrombin)(Cohesion Technologies, PaloAlto, Calif.), and TISSEEL™ sealant (fibrin and thrombin) (Baxter). Theadministration of these tissue adhesives and sealants at the anastomosissite aids in control leakage around the grafted vessel. In addition, awide variety of other useful agents or biomaterials can be similarlydelivered, including hemostatic agents, coagulants, or therapeutic ordiagnostic agents, including both those used in association orconjunction with the anastomosis procedure itself, and those used forrelated or even unrelated conditions and procedures.

[0068] In addition, the invention also contemplates an occlusion deviceconfigured for introduction to the graft site and manipulation vialaproscopic techniques, thereby allowing for closed-chest coronaryartery bypass grafting. Such a device will have a further reducedprofile capable of passing through a standard laproscopic port, and willpreferably be configured such that the actuating mechanisms foractivating the expanding region and clamping member are located remotefrom the shaft assembly and clamp member, thereby facilitatinglaproscopic use of the device. As an example, device 210 of FIG. 8 canbe easily adapted for laproscopic deployment. For example, turn screw272 and associated structures can be reoriented to provide a sleekeroverall profile to the device, thereby accommodating insertion through alaproscopic port. Actuator knobs 227 and 228 can be adapted forreceiving cables that extend remotely from the device. The slide andclamping member actuators can then be remotely activated while thedevice is laproscopically deployed via external manipulation of thecables. Alternative ways to remotely operate the device whilelaproscopically deployed include, e.g., the provision of slide andclamping members that are activated by pistons that are operable throughthe provision of, e.g., compressed air or gas. Again, in such aconfiguration, conduits in fluid communication with the pistons canextend remotely from the device and air or gas can be deliveredexternally via the conduits to drive the pistons and activate thedevice.

[0069] While particular embodiments of the invention have been describedabove, the invention is not intended to be limited to such, but ratherone skilled in the art will recognize that many modifications may bemade that still remain within the scope of the invention, as defined bythe appended claims.

We claim:
 1. An occlusion device for an anastomosis procedurecomprising: a low profile shaft assembly configured for insertion into avessel, said shaft assembly having a lumen extending through said shaftassembly, an expandable region at the distal end of said shaft assemblyand a sealing membrane spanning said expandable region, said expandableregion being deployable from a first low-profile position to a secondexpanded position; means for deploying said expandable region from saidfirst low-profile position to said second expanded position; a clampingmember positioned generally opposite to and moveable towards saidexpanding region, said clamping member having a distal end shapecorresponding to said expanding region in its second expanded position;and a perfusion tube in fluid communication with said shaft assemblylumen, said perfusion tube terminating in a sealing bulb adapted fordeployment within a vessel.
 2. The device of claim 1 wherein saidexpandable region includes the expandable region bowing portions thatbow outward.
 3. The device of claim 2 wherein said bowing portionsfurther comprise a flexible tube having a through slot.
 4. An occlusiondevice for an anastomosis procedure comprising: a housing having a slidelocated therein, said slide mounted to said housing and moveable from afirst position to a second position; a rigid shaft assembly connected tothe slide and having a portion thereof extending from the housing, saidshaft assembly having a lumen extending therethrough; a clamping memberpivotally mounted to the housing, said member having a slide actuatorengaged with said slide, and a lever arm extending from the housing andterminating in a distal end defining a first planar geometry; a flexibletube extending over said extending portion of said shaft assembly, saidtube having a proximal end terminating near the housing, a distal end,and an expanding region proximal to the distal end, said expandingregion having first and second bowing portions and an elastomericsealing membrane over said bowing portions; wherein pivotal movement ofthe clamping member moves said slide from said first position to saidsecond position, thereby moving said rigid shaft assembly from a firstto second position and causing said bowing portions to expand outwardfrom said shaft assembly; and a perfusion tube in fluid communicationwith said shaft assembly lumen, and said perfusion tube terminating in asealing bulb adapted for deployment within a vessel.
 5. The device ofclaim 4 wherein said expanding region is defined by a slot extendingthrough the flexible tube to form said first and second bowing portions.6. The device of claim 4 wherein said pivotal movement of the clampingmember further results in movement of said lever arm toward saidexpanding region.
 7. An occlusion device for an anastomosis procedurecomprising a housing having a slide located therein, said slide moveablefrom a first to a second position; a shaft assembly extending from saidhousing, said shaft assembly having a rod extending through the shaft,an expandable region at the distal end of the shaft assembly, and asealing membrane spanning said expandable region of the shaft assembly,the rod being connected at one end to said slide and at its other end tothe distal end of the shaft, and the expandable region being deployablefrom a first, low-profile position to a second expanded position; amember comprising a clamping member pivotally mounted to said housingand extending therefrom, said clamping member having a distal end shapecorresponding to said expandable region in its second expanded position;and a perfusion tube placed in fluid communication with said shaftassembly, said perfusion tube terminating in a sealing bulb adapted fordeployment within a vessel.
 8. The device of claim 7 further comprisinga slide actuator capable of moving said slide from said first to saidsecond position.
 9. The device of claim 8 wherein said slide actuatorfurther comprises two cam portions having inner and outer edges, saidinner edges defining a receiving groove between said cam portions, andwherein said slide actuator further comprises a knob having first andsecond pins extending therefrom, said first pin being received withinsaid receiving groove and said second pin being received alongside oneof said outer edges, whereby upon rotational movement of said knob, saidfirst pin engages said slide causing translational movement of saidslide from said first position to said second position, and said secondpin moves relative to said slide from the outer edge of said first camportion to the outer edge of said second cam portion.
 10. The device ofclaim 9 wherein said slide is capable of being locked in said first orsecond position.
 11. The device of claim 7 further comprising a clampingmember actuator capable of pivotally moving said member.
 12. The deviceof claim 11 wherein said clamping member actuator comprises a turn screwoperably linked to said member such that rotation of said screwpivotally moves said member.
 13. An occlusion system for an anastomosisprocedure comprising: a low profile shaft assembly configured forinsertion into a vessel, said shaft assembly having a lumen extendingthrough said shaft assembly and terminating in a port at the proximalend of the shaft assembly, an expandable region at the distal end ofsaid shaft assembly, and a sealing membrane spanning said expandableregion, said expandable region being deployable from a first low-profileposition to a second expanded position; means for deploying saidexpandable region from said first low-profile position to said secondexpanded position; a clamping member positioned generally opposite toand moveable towards said expanding region, said clamping member havinga distal end shape corresponding to said expanding region in its secondexpanded position; and a perfusion tube being adapted to be secured tothe shaft assembly port, said tube terminating in a sealing bulb adaptedfor deployment within a vessel.
 14. The system of claim 13 wherein saidexpandable region includes the expandable region bowing portions thatbow outward.
 15. The system of claim 14 wherein said bowing portionsfurther comprise a flexible tube having a through slot.
 16. An occlusionsystem for an anastomosis procedure comprising: a housing having a slidelocated therein, said slide mounted to said housing and moveable from afirst position to a second position; a rigid shaft assembly connected tothe slide, and having a portion thereof extending from the housing, saidshaft assembly having a lumen extending therethrough and terminating ina port at the proximal end of the shaft assembly; a clamping memberpivotally mounted to the housing, said member having a slide actuatorengaged with said slide, and a lever arm extending from the housing andterminating in a distal end defining a first planar geometry; a flexibletube extending over said extending portion of said shaft assembly, saidtube having a proximal end terminating near the housing, a distal end,and an expanding region proximal to the distal end, said expandingregion having first and second bowing portions and an elastomericsealing membrane over said bowing portions; wherein pivotal movement ofthe clamping member moves said slide from said first position to saidsecond position, thereby moving said rigid shaft assembly from a firstto second position and causing said bowing portions to expand outwardfrom said shaft assembly; and a perfusion tube being adapted to besecured to said shaft assembly port, said perfusion tube terminating ina sealing bulb adapted for deployment within a vessel.
 17. The system ofclaim 16 wherein said expanding region is defined by a slot extendingthrough the flexible tube to form said first and second bowing portions.18. The system of claim 16 wherein said pivotal movement of the clampingmember further results in movement of said lever arm toward saidexpanding region.
 19. An occlusion system for an anastomosis procedurecomprising a housing having a slide located therein, said slide moveablefrom a first to a second position; a shaft assembly extending from saidhousing, said shaft assembly having a rod extending through the shaftand terminating in a port at the proximal end of the shaft assembly, anexpandable region at the distal end of the shaft assembly, and a sealingmembrane spanning said expandable region of the shaft assembly, the rodbeing connected at one end to said slide and at its other end to thedistal end of the shaft, and the expandable region being deployable froma first, low-profile position to a second expanded position; a membercomprising a clamping member pivotally mounted to said housing andextending therefrom, said clamping member having a distal end shapecorresponding to said expandable region in its second expanded position;and a perfusion tube placed in fluid communication with said shaftassembly, said perfusion tube terminating in a sealing bulb adapted fordeployment within a vessel.
 20. The system of claim 19 furthercomprising a slide actuator capable of moving said slide from said firstto said second position.
 21. The system of claim 20 wherein said slideactuator further comprises two cam portions having inner and outeredges, said inner edges defining a receiving groove between said camportions, and wherein said slide actuator further comprises a knobhaving first and second pins extending therefrom, said first pin beingreceived within said receiving groove and said second pin being receivedalongside one of said outer edges, whereby upon rotational movement ofsaid knob, said first pin engages said slide causing translationalmovement of said slide from said first position to said second position,and said second pin moves relative to said slide from the outer edge ofsaid first cam portion to the outer edge of said second cam portion. 22.The system of claim 21 wherein said slide is capable of being locked insaid first or second position.
 23. The system of claim 19 furthercomprising a clamping member actuator capable of pivotally moving saidmember.
 24. The system of claim 23 wherein said clamping member actuatorcomprises a turn screw operably linked to said member such that rotationof said screw pivotally moves said member.
 25. A method of partiallyoccluding a vessel using the device of claims 1, 4, or
 7. 26. A methodof performing an anastomosis procedure using the device of any of claims1, 4, or
 7. 27. A method of distally perfusing a vessel while performingan anastomosis procedure using the device of claim 1, 4 or
 7. 28. Amethod of partially occluding a vessel using the system of claims 13,16, or
 19. 29. A method of performing an anastomosis procedure using thesystem of any of claims 13, 16, or
 19. 30. A method of distallyperfusing a vessel while performing an anastomosis procedure using thesystem of claim 13, 16 or 19.